Summary

The goal of this study was to evaluate the initial
efficacy, feasibility, and acceptability of Seeking Safety (SS)
treatment in a sample of incarcerated women with comorbid substance
use disorder (SUD) and comorbid post-traumatic stress disorder
(PTSD). Seeking Safety, a cognitive-behavioral psychotherapy
treatment, is a psychosocial treatment for women with comorbid PTSD
and SUD and, at the time this study was conducted, it was the
treatment with the most efficacy data for this population. SS
treatment appears to be a promising intervention for incarcerated
women with PTSD and SUD because (1) the treatment targets many of the
deficits found in this population that may interfere with their
recovery and place these women at risk for reoffending (such as
impulsiveness, anger dyscontrol, and maladaptive lifestyle
activities), and (2) it teaches skills to manage these problematic
behaviors. This study aimed to conduct an open feasibility trial of
Seeking Safety treatment in a sample of six incarcerated women with
SUD and PTSD and to conduct a randomized controlled pilot study to
evaluate the initial efficacy, feasibility, and acceptability of the
proposed treatment as an adjunct to treatment as usual (TAU), compared
to a TAU control group in a sample of 22 incarcerated women with
comorbid PTSD and SUD. The primary hypothesis was that, compared to
the TAU condition, women in the SS treatment condition would have less
severe drug and alcohol use as well as fewer PTSD symptoms and legal
problems after intervention, and at six weeks and three months after
release. The first six participants recruited for the study received
SS group treatment as an adjunct to the treatment provided by the
Discovery Program, the substance abuse treatment program in the
minimum security arm of the Women's Facility of the Adult Correctional
Institution in Providence, Rhode Island. The remaining participants
were randomly assigned to either the control group (TAU) or to a group
that received SS treatment as an adjunct to TAU. The treatment groups
were conducted by clinicians who worked as substance abuse therapists
in the Discovery Program and a clinical psychologist from Brown
University. All SS therapists received training in delivering SS
therapy from Dr. Lisa Najavits, who developed SS
treatment. Assessments were conducted at pretreatment, post-treatment
during incarceration, and three and six months postrelease for
PTSD-related measures. Measures of severity of substance abuse and
legal problems were taken at pretreatment, as well as at the six- and
12-week postrelease intervals. Measures were taken with a variety of
clinical instruments, including the Addiction Severity Index (ASI),
the Structured Clinical Interview for DSM-IV (SCID) module on
substance use, the Clinician Administered Post-Traumatic Stress
Disorder Scale-I (CAPS-I), the Trauma History Questionnaire (THQ), the
Helping Alliance Questionnaire-II (HAQ-II), the Client Satisfaction
Questionnaire, and the End-of-Treatment Questionnaire. Basic
demographic data were also collected from administrative
records. Variables include alcohol, drug, and legal composite scores
at pretreatment and post-treatment, number of relapses, whether the
woman returned to prison, whether the woman lied about substance
abuse, use of particular substances one month prior to prison and
during lifetime, PTSD indicators of frequency and intensity, total
client satisfaction scores, patients' ratings of therapists and
treatment, and trauma scales for crime, sexual abuse, and physical
abuse. Demographic variables include age, ethnic background,
education, first time in prison, the nature of the current conviction,
and number of arrests with convictions.

Citation

Zlotnick, Caron. Treatment of Incarcerated Women with Substance Use Disorder and Post-traumatic Stress Disorder in Providence, Rhode Island, 1999-2001. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2005-11-04. https://doi.org/10.3886/ICPSR03416.v1

Date of Collection

Data Collection Notes

Study Purpose

The goal of this study was to evaluate the
initial efficacy, feasibility, and acceptability of Seeking Safety
(SS) treatment in a sample of incarcerated women with comorbid
substance use disorder (SUD) and comorbid post-traumatic stress
disorder (PTSD). Seeking Safety, a cognitive-behavioral psychotherapy
treatment, is a psychosocial treatment for women with comorbid PTSD
and SUD and, at the time this study was conducted, it was the
treatment with the most efficacy data for this population. SS
treatment appears to be a promising intervention for incarcerated
women with PTSD and SUD because (1) the treatment targets many of the
deficits found in this population that may interfere with their
recovery and place these women at risk for reoffending (such as
impulsiveness, anger dyscontrol, and maladaptive lifestyle
activities), and (2) it teaches skills to manage these problematic
behaviors. This study aimed to conduct an open feasibility trial of
Seeking Safety treatment in a sample of six incarcerated women with
SUD and PTSD and to conduct a randomized controlled pilot study to
evaluate the initial efficacy, feasibility, and acceptability of the
proposed treatment as an adjunct to treatment as usual (TAU), compared
to a TAU control group in a sample of 22 incarcerated women with
comorbid PTSD and SUD. The primary hypothesis was that, compared to
the TAU condition, women in the SS treatment condition would have less
severe drug and alcohol use as well as fewer PTSD symptoms and legal
problems after intervention, and at six weeks and three months after
release.

Study Design

The first six participants recruited for the study
received SS group treatment as an adjunct to the treatment provided by
the Discovery Program, the substance abuse treatment program in the
minimum security arm of the Women's Facility of the Adult Correctional
Institution in Providence, Rhode Island. The remaining participants
were randomly assigned to either the control group (TAU) or to a group
that received SS treatment as an adjunct to TAU. The treatment groups
were conducted by clinicians who worked as substance abuse therapists
in the Discovery Program and a clinical psychologist from Brown
University. All SS therapists received training in delivering SS
therapy from Dr. Lisa Najavits, who developed SS treatment. SS
treatment focuses on developing a specific cognitive, behavioral, or
interpersonal skill, with each skill designed to combat both SUD and
PTSD simultaneously. The primary goals of the treatment are abstinence
from substances and personal safety. Assessments were conducted at
pretreatment, post-treatment during incarceration, and three and six
months postrelease for PTSD-related measures. Measures of severity of
substance abuse and legal problems were taken at pretreatment, as well
as at the six- and 12-week postrelease intervals. Measures were taken
with a variety of clinical instruments. The Addiction Severity Index
(ASI) was used at intake to assess change in the severity of substance
abuse in the past 30 days. The legal composite score from the ASI was
used to assess change in criminal activities. The legal composite
index contained information about arrests, incarcerations, and
engagement in criminal activity since release from prison. At intake
the women were assessed for legal problems in the 30 days prior to
entering prison. The Structured Clinical Interview for the DSM-IV
(SCID) module on substance use was used to provide a diagnosis of
alcohol or drug use or dependence. The Clinician Administered
Post-Traumatic Stress Disorder Scale-I (CAPS-I) provided a diagnosis
of PTSD as well as an assessment of the degree of PTSD symptoms. To
assess lifetime history of trauma, the Trauma History Questionnaire
(THQ) was given at pretreatment. This measure yielded four frequency
scores for physical, sexual, general disaster, and crime-related
traumas. At post-treatment the participants' views of treatment were
assessed on the Helping Alliance Questionnaire-II (HAQ-II) and the
Client Satisfaction Questionnaire. At post-treatment the patients'
perceptions of the helpfulness of components of SS treatment were
assessed with the End-of-Treatment Questionnaire. Basic demographic
data, such as age, education, and criminal history, were also
collected from administrative records.

Sample

Not applicable.

Universe

Women inmates suffering from PTSD and SUD in Rhode
Island.

Unit(s) of Observation

Individuals.

Data Source

Demographic data were collected from administrative
records. Clinical data were obtained from the Addiction Severity
Index, the Structured Clinical Interview for DSM-IV, the Clinician
Administered Post-Traumatic Stress Disorder Scale-I, the Trauma
History Questionnaire, the Helping Alliance Questionnaire-II, the
Client Satisfaction Questionnaire, and the End-of-Treatment
Questionnaire.

Data Type(s)

administrative records data, and clinical data

Description of Variables

Variables include alcohol, drug, and legal
composite scores at pretreatment and post-treatment, number of
relapses, whether the woman returned to prison, whether the woman lied
about substance abuse, use of particular substances one month prior to
prison and during lifetime, PTSD indicators of frequency and
intensity, total client satisfaction scores, patients' ratings of
therapists and treatment, and trauma scales for crime, sexual abuse,
and physical abuse. Demographic variables include age, ethnic
background, education, first time in prison, the nature of the current
conviction, and number of arrests with convictions.

Original Release Date

2002-11-27

Version Date

2005-11-04

Version History

2002-11-27 ICPSR data undergo a confidentiality review and are altered when necessary to limit the risk of disclosure. ICPSR also routinely creates ready-to-go data files along with setups in the major statistical software formats as well as standard codebooks to accompany the data. In addition to these procedures, ICPSR performed the following processing steps for this data collection:

Standardized missing values.

Checked for undocumented or out-of-range codes.

2005-11-04 On 2005-03-14 new files were added to one
or more datasets. These files included additional setup files as well
as one or more of the following: SAS program, SAS transport, SPSS portable,
and Stata system files. The metadata record was revised 2005-11-04 to
reflect these additions.

Notes

The public-use data files in this collection are available for access by the general public. Access does not require affiliation with an ICPSR member institution.

The citation of this study may have changed due to the new version control system that has been implemented.